RSS Medical Articles

What Should Patients Be Told About Noninferiority Studies?
Κύριακη, 10.01.2017, 03:00am
A noninferiority trial is a study in which a new treatment is compared with an existing, already available treatment, but in which the statistical analysis does not evaluate the possible superiority of the new treatment. Rather, it tests whether the new treatment is not worse than the existing treatment, using a prespecified threshold for the evaluation (the “noninferiority margin”). In this issue ofJAMA Internal Medicine, Doshi et al explore both what patients are being told, and what they should be told, about the purpose of the research when being asked to participate in a noninferiority trial designed to test the comparative efficacy and safety of antibiotics.
The Ideal Blood Pressure Target for Patients With Chronic Kidney Disease
Κύριακη, 10.01.2017, 03:00am
Hypertension is the number 1 cardiovascular risk factor, and its treatment prevents major cardiovascular events and lowers mortality. Most patients with chronic kidney disease (CKD) have hypertension, and CKD is characterized by extremely high cardiovascular disease rates. It is thus not surprising that antihypertensive therapy is a universal part of CKD management, and its benefits are broadly accepted. Notwithstanding the general consensus about the pathophysiologic relevance of hypertension, there has been controversy in the medical community regarding the ideal therapeutic blood pressure (BP) target in patients with CKD. Fueling this controversy are concerns about the presence of a J-curve and the paucity of dedicated randomized clinical trials (RCTs) testing the effects of BP lowering to levels that approach physiologic normalcy (ie,<120/80 mm Hg). These uncertainties are further accentuated when assessing the effects of antihypertensive therapy on all-cause mortality, which includes deaths with causes entirely unrelated to hypertension.
Toward Improving Patient Safety
Κύριακη, 10.01.2017, 03:00am
In this issue ofJAMA Internal Medicine,Baker and colleagues present the case of a woman in her 90s who experienced fatal complications after implantation of a cardiac resynchronization therapy pacemaker (CRT-P). The authors make educational points in this Teachable Moment about the possible harms of placing a device in a high-risk patient with less than clear indications. There is, however, more we can learn from this story.
Eliminating Creatine Kinase–Myocardial Band Testing in Suspected ACS
Κύριακη, 10.01.2017, 03:00am
This Special Communication discusses the benefits of eliminating creatine kinase–myocardial band testing in suspected acute coronary syndrome.
Cardiac Resynchronization Therapy—Does One Size Fit All?
Κύριακη, 10.01.2017, 03:00am
This Teachable Moment illustrates the complexity of determining the appropriateness and timing of cardiac resynchronization therapy in the management of heart failure.
Unnecessary Staging Imaging in Early-Stage Breast Cancer
Κύριακη, 10.01.2017, 03:00am
This Teachable Moment uses the details of a case report to evaluate the risks and benefits of staging imaging in early-stage breast cancer.
The Harms of Empirical Bowel Regimens
Κύριακη, 10.01.2017, 03:00am
This Teachable Moment describes a hospitalized patient with nosocomial diarrhea caused by unnecessary prescription of laxatives and discusses the potential harms of this routine practice.
Macroscopic T-Wave Alternans
Κύριακη, 10.01.2017, 03:00am
A man in his 40s with a history of alcohol abuse and hepatitis C cirrhosis presented to the emergency department with several weeks of subjective fever, abdominal cramping, and diarrhea. He had no history of cardiovascular disease and was not taking medications or supplements.
Enactment of a “Stand Your Ground” Law and Homicides in Florida
Κύριακη, 10.01.2017, 03:00am
This study analyzes data on homicides to evaluate changes in the number of justifiable and unlawful homicides in Florida following the enactment of a “stand your ground” law.
Hours Worked Among US Dual Physician Couples With Children
Κύριακη, 10.01.2017, 03:00am
This Research Letter estimates weekly hours worked for married, dual-physician couples.
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